Solitary fibrofolliculoma on the nasal septum: a case report

Fibrofolliculoma is a benign, perifollicular, connective tissue tumor that usually arises in the form of multiple lesions; it is rarely seen as a solitary lesion. The lesions are clinically asymptomatic, 2 to 4 mm skin-colored, soft dome-shaped papules. Here, we report a patient who visited our hospital with a palpable lesion on the nasal septum. The lesion did not cause pain upon palpation, and nasal endoscopy confirmed an irregular wart-like lesion measuring 6 × 6 mm in the left anterior nasal septum near the columella. Other otolaryngology findings were normal, and there were no similar lesions in other parts of the body. None of the patient’s family members were known to have had such lesions. An excisional biopsy was performed on the mass for removal of the lesion, and histological examination confirmed the lesion as fibrofolliculoma. We report the first case of solitary fibrofolliculoma in the nasal septum in a healthy 62-year-old woman along with a review of the relevant literature.

Effect of Body Mass Index on Upper Airway Obstruction as Revealed by Drug-Induced Sleep Endoscopy in Patients With Sleep-Disordered Breathing / 대한이비인후과학회지

Background and Objectives@#Drug-induced sleep endoscopy (DISE) usefully determines the sites of airway obstruction in patients with sleep-disordered breathing. It is widely accepted that obesity increases obstructive sleep apnea. However, no study has explored how and where obesity causes obstructions. In this study, we described the patterns of upper airway obstruction revealed by DISE in patients of various body mass indices (BMIs) with sleep-disordered breathing.Subjects and Method All subjects had sleep-disordered breathing and underwent DISE. Endoscopic findings at the retropalatal (upper lateral, upper anteroposterior [AP]) and retrolingual (lower lateral, lower AP) levels were graded; obstruction was complete (2), partial (1), or none (0). Subjects with BMI 30 group) were compared using a dummy variable; to this end, we employed R ver. 4.0.5. @*Results@#For the total of 153 patients reviewed, the mean age was 43.1±12.2 years and the mean BMI was 26.0±3.4 kg/m2. At the retropalatal AP level, the DISE grade was significantly higher in the 2530 group (p=0.248). At the retropalatal lateral level, significant increases were evident in both of the higher BMI groups (p=0.06 and p=0.024, respectively). No significant relationship was found at the retrolingual level. @*Conclusion@#In terms of the retropalatal AP and lateral diameters, a higher BMI is associated with a greater incidence of more severe obstruction.

Relationship Between Adenotonsillar Size and Snoring Sound: Acoustic Analysis / 대한이비인후과학회지

Background and Objectives@#The most common cause of snoring in children is enlarged tonsils and adenoids. However, there is insufficient evidence to determine whether the subjective measurement of tonsil hypertrophy, the most common prevailing method, reflects the actual tonsil size and volume. Therefore, we tried to determine whether the subjective grading of tonsil size and actual tonsil volume is related, and whether tonsil volume, weight, and adenoid index are correlated with the acoustic analysis of snoring.Subjects and Method The study was conducted on 21 children between the ages of 4 and 15 who came for tonsillectomy and adenoidectomy due to snoring symptoms. The degree of adenotonsillar hypertrophy was measured using the Brodsky grading scale and adenoid index. After tonsillectomy, the volume and weight of resected tonsil were measured. For acoustic analysis, the Praat software was used to determine formant frequency and sound intensity. A linear regression model and a dummy variable were used to determine the correlation between the quantitative values of tonsil, adenoid and the result of acoustic analysis. @*Results@#The Brodsky tonsil grade tended to match the actual tonsil volume, but it was not statistically significant (p=0.073). There was no correlation between snoring intensity and actual tonsil volume, weight, and adenoid index. Formant frequency 1 and 2 were statistically negatively correlated with the actual tonsil volume (p=0.011, 0.002). @*Conclusion@#The study confirmed that the acoustic analysis of pediatric snoring could be a screening test to predict tonsil volume and changes in the vocal tract due to tonsil hypertrophy.

Snoring Sound Intensity and Formant Frequencies by Sleep Position in Patients with Positional Obstructive Sleep Apnea / 대한이비인후과학회지

Background and Objectives@#Snoring is the most common symptom of obstructive sleep apnea (OSA) and is caused by turbulent airflow due to narrowing of the upper airways. In patients with positional OSA, a change in sleep posture from supine to lateral is known to reduce snoring and sleep apnea. This study was performed to compare changes in snoring sound intensity and formant frequencies according to sleep position.Subjects and Method A total of 19 patients (male: 18; female: 1) diagnosed with positional OSA by polysomnography (PSG) were enrolled in this study. The snoring sounds recorded during PSG were analyzed acoustically and compared according to sleep position (i.e., supine vs. lateral). @*Results@#Snoring disappeared on changing sleep position in five patients, all of whom had Apnea-Hypopnea Index (AHI) <15. In other patients, the snoring sounds tended to decrease with posture change, and the degree of decrease was inversely proportional to AHI (p=0.015) and respiratory disturbance index (RDI) (p=0.013). Formant frequencies 1, 3, and 4 (F1, F3, and F4, respectively) decreased when sleeping in the lateral position (p=0.02, 0.03, and 0.01, respectively). @*Conclusion@#In patients with positional OSA, a change in sleep posture from supine to lateral during sleep reduced the intensity and frequency of snoring sound.

The Effect of Adenotonsillectomy on Korean Children's Voice / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#Adenotonsillectomy is a commonly performed surgical procedure carried out by otolaryngologists for children. Anatomical changes to the vocal tract occur after the surgery and may alter the patient's voice. This study evaluated the effects of adenotonsillectomy on the voice in Korean children.SUBJECTS AND METHOD: total of 20 children who underwent adenotonsillectomy were enrolled. The speech of patients was recorded before and at one month of the surgery and acoustic features, especially the formant frequency, were analyzed. Perceptual analysis was also carried out and the Pediatric Voice Handicap Index (PVHI) questionnaire was used to assess subjective changes in the children's voice and the effects of these changes on social functions.@*RESULTS@#Acoustic analysis revealed significant decreases in the vowel /i/ in the second formant, compact-diffuse, and grave-acute features of the voice (p=0.026, 0.022, and 0.031, respectively). A significant decrease was also observed in the intensity of the voice for the vowel /u/ (p=0.025). Perceptual analysis revealed that 86.6% of patients' voice recordings had post-operative changes. The mean preoperative PVHI score was 2.70±3.37, which decreased to 1.65±2.21 (p=0.011) after the surgery.@*CONCLUSION@#The results suggest that adenotonsillectomy affects Korean children's voices both acoustically and perceptually.

The Relationship between the Causative Allergens of Allergic Diseases and Environments in Korea Over a 8-Year-Period: Based on Skin Prick Test from 2006 to 2015

BACKGROUND AND OBJECTIVES: The present study evaluated the results of skin prick test using 55 allergens at 20 centers in the Republic of Korea in 2006, 2010, and 2014–2015. The aim was to assess changes in the positive rate of allergens according to temporal, regional, and environmental factors. MATERIALS AND METHODS: In total, 20 hospitals were selected based on the population distribution in the Republic of Korea. A skin prick test panel comprising 55 aeroallergens was distributed to 18 hospitals for this prospective study. The 2006 and 2010 skin prick test results were collected and analyzed retrospectively from 20 hospitals, while the 2014/2015 skin prick test results (from June 2014 to May 2015) were collected prospectively from 18 hospitals. RESULTS: A total of 14,897 SPT test results were analyzed: 4,319 in 2006, 7,431 in 2010, and 1,852 in 2014/2015. The overall rate of skin prick test positivity to more than two allergens was significantly higher in males than females. The positive rates of alder pollens and birch, oak and ragweed pollen positivity were increased in older patients. Several positive rates were increased according to the temperature in spring. The positive rates for beech pollen, birch pollen, hazel pollen, oak pollen, Tyrophagus putrescentiae, mugwort, cat, Acarus siro, Lepidoglyphus destructor and Tyrophagus putrescentiae were significantly increased, while those of Cult rye pollen and dandelion were significantly decreased over the three test periods. The overall positive rate for allergens in Jeju province varied significantly from Seoul and other cities. CONCLUSION: Change in the positive rate of multiple aeroallergens was evaluated in the Republic of Korea over time. Our findings can be used to recommend aeroallergens suitable for inclusion in skin prick test panels in the Republic of Korea and will facilitate further investigation of changes in the patterns of allergic diseases.

The Utility of Adenotonsillectomy to Treat Snoring in Children: Acoustic Evaluation Using Smartphones / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Adenotonsillectomy is a highly effective treatment for obstructive sleep apnea symptoms in children. In this study, to investigate the effects of adenotonsillectomy on snoring in children, we analyzed and compared snoring sounds recorded using a smartphone before and after adenotonsillectomy. We also determined whether it is possible to use acoustic analysis to monitor snoring in children. SUBJECTS AND METHOD: A total of 20 children diagnosed with snoring and had undergone adenotonsillectomy performed by the same surgeon were enrolled for the study. Snoring was recorded by patients' caregivers using smartphones before and after the surgery (mean of 8.5 days) and analyzed. Questionnaires were conducted by telephone survey at 3 months and 12 months after the surgery to determine snoring status. RESULTS: Snoring completely ceased in 25% of patients and decreased in the remaining 75% during the immediate follow-up period (mean of 8.5 days; from 58.07±9.35 dB to 42.59±7.89 dB, p<0.001), and disappeared in all of the patients by 3 months after adenotonsillectomy. Snoring recurred only in one patient after 1 year. A frequency analysis offered no evident statistically significant changes during the immediate follow-up period, indicating that although snoring volume had decreased, no anatomical change had developed in the patient. Spectrography was useful in investigating the snoring patterns before and after adenotonsillectomy. CONCLUSION: The results showed that acoustic analysis of snoring sounds obtained using a smartphone may be useful for monitoring snoring during follow-up after adenotonsillectomy in pediatric snoring patients.

A Case of Nasal Swell Body (Septal Turbinate) Combined with Pneumatization of Perpendicular Plate of the Ethmoid Bone

The "nasal swell body" (NSB) or septal turbinate is a distinct structure of the anterior nasal septum that is observed on endoscopic and radiographic examination. It is primarily a glandular rather than a venous formation that is comprised of septal cartilage, bone, and thick mucosal lining. It is commonly found in patients with symptoms of chronic sinusitis and allergic rhinitis, and is linked to septal deviation. Space occupying lesions of the septum such as tumors, mucoceles, and pneumatization of the septum can lead to anatomical and functional disorders such as nasal obstruction and sinusitis, while more serious clinical conditions can develop when these lesions are combined with the NSB. Recently, there has been emphasis on the functional aspects of the NSB. It is especially being emphasized for clinicians to pay attention to the NSB and its connection with the stuffy nose. We report an interesting case of the NSB combined with pneumatization of the perpendicular plate of the ethmoid bone causing severe nasal obstruction and repetitive sinusitis along with a literature review.

A Study on Voice Change after Septoplasty with Turbinoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Septoplasty with turbinoplasty has the potential to affect voice because it alters the vocal tract. We conducted a study to evaluate the postoperative voice changes and aid using subjective and objective data regarding the effect of surgery. SUBJECTS AND METHOD: To rule out gender bias, only 23 male patients were enrolled. Voice change was analyzed by a subjective test through a questionnaire and an objective test through acoustic analysis. During each recording session, the subject uttered the words [

Cholesterol Granuloma of Nasal Septum

Cholesterol granulomas are inflammatory deposits commonly found in the mastoid antrum and air cells of temporal bone. They rarely occur in the nose. Here, we report an extremely rare case of cholesterol granuloma in the nasal septum, and include a short literature review. The clinical characteristics, pathology, and surgical treatment are also discussed.

Five-Year Subjective Outcomes of Obstructive Sleep Apnea Surgery: A Multiinstitutional Study

OBJECTIVES: To evaluate the effect of obstructive sleep apnea (OSA) surgery on long-term (5-year) subjective outcomes, including sleep disordered breathing (SDB) symptoms and other complications, in patients with OSA. METHODS: We enrolled patients who underwent diagnostic polysomnography for OSA between January 2006 and December 2006 in ten hospitals. Patients either were treated for OSA or were not treated for OSA. All patients completed a brief telephone survey regarding their SDB signs and symptoms (e.g., snoring, apnea, nocturnal arousals, and daytime sleepiness), positive airway pressure (PAP) compliance, and any adverse effects of either the surgery or PAP. A positive subjective outcome for either surgery or no treatment was taken to be the alleviation of apnea, defined as a > or =50% increase in score. A positive subjective outcome (compliance) for PAP was defined as a PAP usage of > or =4 hours per night and > or =5 days per week. RESULTS: A total of 229 patients were included in this study. Patients were divided into three groups: a surgery group (n=87), a PAP group (n=68), and a control (untreated) group (n=74). The surgery group exhibited significant improvement in all SDB symptoms compared with the control group. The long-term subjective outcomes of the surgery (52.9%) and PAP (54.4%) groups were significantly better than those of the control group (25.0%). The subjective outcome of the surgery group was not significantly different from that of the PAP group. The overall surgical complication rate was 23.0% (20 of 87) in the surgery group, and 55.0% (22 of 40) of all patients with PAP experienced adverse effects. CONCLUSION: The extent of SDB symptoms was consistently improved in patients with OSA at 5 years postsurgery. Information about the potential long-term subjective outcomes should be provided to patients when considering surgery.

The Usefulness of Picture Consonant Articulation Test Determining the Effectiveness of Frenotomy in Ankyloglossia Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To determine the extent of speech articulation disorder in ankyloglossia patients and to determine whether picture consonant articulation test has potential as a screening test to predict the outcome of surgery. SUBJECTS AND METHOD: A total of 35 patients (25 boys and 10 girls with mean age of 3.69+/-1.18 years) with ankyloglossia who underwent frenotomy and recovered completely without complications were enrolled in this study. We examined the correlation between the subjective satisfaction of parents and the results of picture consonant articulation test. RESULTS: In the picture consonant articulation test, 20 patients (20/35, 57.14%) needed postoperative speech therapy. When the resutls of preoperative picture consonant articulation test and postoperative parents' subjective satisfaction were compared, "normal" had a satisfaction score of 4.53+/-0.74 points, "consider" had 3.89+/-1.05 points, and "demand" had 3.27+/-1.45 points. When a postoperative speech therapy was required, parents' satisfaction decreased (correlation coefficient r=-0.456). CONCLUSION: The preoperative picture consonant test in our study showed potential as a screening test for predicting the outcome of surgery for ankyloglossia patients.

A Case of Sclerosing Polycystic Adenosis of Parotid Gland / 대한이비인후과학회지

Sclerosing polycyctic adenosis (SPA) is a rare lesion of unknown etiology morphologically resembling fibrocystic changes of the breast. To our knowledge, 53 cases of SPA have been reported in the literature to date. SPA is well circumscribed, yet not encapsulated. Sclerosing adenosis and cystic ducts with frequent apocrine-like cells were noted. Familiarity with the cytologic and histological features of SPA is very important in making the correct diagnosis. The differential diagnosis of SPA includes polycystic disease, sclerosing sialadenitis and benign/malignant glandular neoplasias. Although atypia ranging from mild dysplasia to carcinoma in situ can occur in some cases, SPA has a favorable outcome. In this article, we describe a 38-year-old male patient diagnosed with SPA in the parotid gland.

A Case of Leiomyoma in the Inferior Turbinate

Leiomyoma is a benign myogenic tumor may occur whenever smooth muscle is present. The most common locations are the uterus, alimentary tract, skin, and subcutenous tissue. Leiomyoma of the nasal cavity and paranasal sinus is rare because of the paucity of smooth muscle on the nose. We experienced a case of leiomyoma originating in the left inferior turbinate in a 58-year-woman. It was successfully removed by an endoscopic surgery. We discussed with a review of the literatures.

A Case of Leiomyoma in the Inferior Turbinate

Leiomyoma is a benign myogenic tumor may occur whenever smooth muscle is present. The most common locations are the uterus, alimentary tract, skin, and subcutenous tissue. Leiomyoma of the nasal cavity and paranasal sinus is rare because of the paucity of smooth muscle on the nose. We experienced a case of leiomyoma originating in the left inferior turbinate in a 58-year-woman. It was successfully removed by an endoscopic surgery. We discussed with a review of the literatures.

Analysis of Correlation between Results of Polysomnography and Obstructive Structure by Drug-Induced Sleep Endoscopy in Obstructive Sleep Apnea Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Polysomnography (PSG) is useful for the diagnosis of obstructive sleep apnea (OSA) and the analysis of its occurrence and severity. Nevertheless, physical examination and PSG are not sufficient to localize the obstructed structure before operation. Drug-induced sleep endoscopy (DISE), on the other hand, is expected to provide an accurate diagnosis as it can be used to evaluate the intensity of operative effect and can minimize additional unnecessary procedures. The aim of this study is to analyze correlation between the results of polysomnography and obstructive structure by DISE in OSA Patients. SUBJECTS AND METHOD: This study was conducted on 75 patients, who were diagnosed with OSA by PSG and DISE. Obstruction levels and individual structures were classified by modified VOTE classification. The patients were divided into groups according to the results of PSG and BSI; the correlation between DSI results and each of these groups were analyzed. RESULTS: There were no statistically significant differences in obstruction levels between PSG data and DISE finding. Obese patients, positional-dependent OSA and sleep stage non-dependent OSA (NREM OSA) groups showed more obstruction on the lateral pharyngeal wall. Severe OSA groups showed more obstruction on tonsils. Obese patient groups revealed more obstruction on tongue base, but did not contribute to statistically significant results. CONCLUSION: In our study, obese patients, severe OSA, positional-dependent OSA and NREM OSA groups tended to exert greater influence on the obstruction of lateral pharyngeal wall. Surgeons should be aware of these findings when performing sleep surgery.

A Subjective and Acoustic Analysis on Voice Change after Endoscopic Sinus Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Some chronic sinusitis patients complain that voice change, which occurs during surgeries such as endoscopic sinus surgery (ESS), can lead to changes in the vocal organ. The purpose of this study is to analyze the effect of ESS on voice by questionnaire and voice analysis. SUBJECTS AND METHOD: Thirty patients (male 15, female 15) who had underwent ESS were enrolled. All patients had sinusitis confirmed by preoperative CT scan. We analyzed subjective voice impairment by way of questionnaire (Korean-Version of Voice Handicap Index, KVHI) and objective voice impairment by Computerized Speech Laboratory one day preceding and at one month following the surgery. Finally, the subjective impairment of voice was analyzed by subjective questionnaire at postoperative 6 months. In objective analysis, we analysis 11 ESS cases on the formant frequencies of five vowels (/a/, /i/, /u/, /e/, /o/) and three nasal consonants (/namu/, /nuna/, /umma/). RESULTS: In the questionnaire (KVHI), there was a little change in the functional, physical and emotional field but the results were not statistically significant (p>0.05). In the voice analysis, the first formant frequencies of /a/, /u/, the third formant frequency of /o/ of vowel and /a/ of /namu/ of nasal consonant were significantly increased postoperatively compared to those of the preoperative status (p<0.05). However, there was no major change. There was no subjective voice impairment at 6 months after operation. CONCLUSION: After ESS, some voice impairment were observed in KVHI and some formant frequencies were increased in the objective voice analysis but without serious major voice changes. We conclude that ESS is relatively safe from voice point of view; however, for some professional voice users, particular attention needs to be paid regarding fine voice changes.

Retrospective Analysis of Endoscopic Septoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We reviewed retrospective data of patients who underwent endoscopic septoplasty over 5 years and provide clinical information about endoscopic septoplasty. SUBJECTS AND METHOD: The medical records of patients who underwent endoscopic septoplasty were reviewed retrospectively for clinical symptoms, surgical methods, intraoperative technique, operation time, postoperative complications and results. RESULTS: Nasal obstruction was the most common presenting symptom. Among patients, endoscopic septoplasty alone was performed in 290 cases. Among 290 cases, 57 cases were of broad based septal defection, 13 cases septal deflection with septal spur, 16 cases isolated septal spur and 4 cases limited posterior septal deflection. The mean operation time was 32.48+/-2.76 minutes. No major complication occurred in the immediate postoperative period. Minor complications included septal hematoma (3.79%) and postoperative hemorrhage (1.03%). Sixty-five patients received statistically validated measures of Visual Analog Scale (VAS) at 1 month and 6 months after surgery. VAS score decreased statistically from 7.75 to 0.81 at 6 mon-ths after operation (p<0.05). CONCLUSION: Endoscopic septoplasty is a relatively safe and effective technique used to treat various types of septal pathology such as classical septal deviation, septal spur and isolated septal deflection. Endoscopy with video imaging system is valuable for education.

Clinical Safety of PMR(Palatal Muscle Resection) In Which Performed OSAS Patients

BACKGROUND AND OBJECTIVES: The purpose of this study was to analyze clinical safety of PMR(Palatal Muscle Resection) in obstructive sleep apnea patients. MATERIALS AND METHODS: Fourteen Patients underwent only PMR were reviewed retrospectively. ESS(Epworth Sleepiness Scale) was analyzed after PMR surgery to assess surgical results. Visual Analogue Scale were reviewed to evaluate postoperative pain. Eustachian tube function test, voice analysis, and measurement of forced expiration power were done after two months of surgery. RESULTS: ESS were improved after PMR. There were little postoperative pain. There was no significant change is observed vowel sounds except /u/ nor postoperative nasalization in voice, Eustachian tube dysfunction and change of expiration power. CONCLUSION: PMR may be regarded clinically safe surgery in obstructive sleep apnea patient.

A Case of Chondro-Osseous Respiratory Epithelial Adenomatoid Hamartoma Originated from Nasal Cavity

Hamartoma is a non-malignant malformation or developmental anomaly of tissue development that may occur anywhere in the body but is rarely reported in the nasal cavity, paranasal sinuses, or nasopharynx. Chondro-osseous respiratory epithelial adenomatoid hamartoma (CO-REAH) of the nasal cavity is exceedingly rare, and can be confused both grossly and microscopically with more serious sinonasal tumors. We present the case of a 58-year-old man with a nasal cavity mass, which was removed by an endonasal approach. Radiographic and histological studies permitted a diagnosis of CO-REAH in this case.